FIVE HILLS TRAINING AREA, Mongolia -- The typical adult human body contains five liters of blood. Responsible for transporting oxygen and nutrients to the cells and removing waste on its return trip through miles of arteries, veins and capillaries, blood is life.
Lose too much blood, and a person descends into hypovolemic shock. If more is lost, it can be fatal.
The heavy consequences of blood loss are why stopping the bleeding and saving service members' lives is serious business for Staff Sgt. Stephen Behrens, Alaska Army National Guard Medical Detachment training noncommissioned officer.
Behrens, other U.S. medical personnel and their Mongolian Armed Forces counterparts instructed Tactical Combat Casualty Care during Exercise Khaan Quest 2018 June 14-28 at Five Hills Training Area, Mongolia.
Khaan Quest is a regularly scheduled, multinational exercise co-sponsored by U.S. Pacific Command and hosted annually by the Mongolian Armed Forces. Khaan Quest 18 is the latest in a continuing series of exercises designed to promote regional peace and security. This year's exercise marks the 16th anniversary of this training event.
U.S., Mongolian Armed Forces, and 16 other nations participate this year in the Tactical Combat Casualty Care lane, just one part of a round-robin style gauntlet of training events such as crowd control and convoy operations.
Behrens said medical personnel can't be everywhere, and it is often up to service members of every job description to stabilize a wounded comrade before they can be evacuated to medical care.
"Combat casualty care is the method we use to sustain life on the battlefield, then get them from the point of injury to (higher levels of) care," Behrens said.
Central to the training is the MARCH algorithm, standing for massive bleeding, airway control, respiratory support, circulation and hypothermia prevention.
Behrens taught students to conduct a blood sweep, visually inspecting the patient for any obvious signs of bleeding before patting the wounded person down for signs that are less clear.
Most dangerous is arterial bleeding. Arteries are the blood superhighway of the vascular system, feeding crimson platelets at high pressure to smaller veins and capillaries.
Behrens said the best way to stop arterial bleeding, signified by bright-red blood, is by way of fitting a tourniquet above the wound. Students practiced with partners fitting the device, which is simply a nylon belt-like constrictive device that compresses blood vessels to stop the bleeding.
Second Lt. Sonya Hood, platoon leader for the 297th Regional Support Group contingent, winced when platoon member Pfc. Jessica Shields fitted the officer with the tourniquet, cranking the pressure on Hood's femoral artery. Behrens said Tactical Combat Casualty Care measures can be uncomfortable for the patient, but they save lives.
In a frenetic firefight, rendering medical aid to a hurt comrade becomes an exercise in pressure-cooker multi-tasking.
During a simulated movement-to-contact maneuver, Spc. Jahmoi Hodge, a squad leader under Hood's command, swept his eyes across the horizon scanning his sector. Following the tell-tale crack-crack-crack of an AK-47 rifle, Hodge dropped flat.
"Twelve o'clock, 200 meters, enemy squad in the open," Hodge called, giving direction, distance and description of the threat.
After the platoon neutralized enough of the enemy to be able to move, Hodge heard an urgent call for assistance.
"Help, help, I'm shot!," his legs covered in simulated gunshot wounds, cried U.S. Navy Hospital Corpsman 3rd Class John Bustamonte, a corpsman assigned to III Marine Expeditionary Force.
It took nearly a minute for Hodge to close the distance. The Soldier sprinted and dropped, dashed and took cover, returning fire as he rushed toward Bustamonte's urgent calls. By the time he reached the stricken Sailor, Hodge struggled to breathe fast and deep enough to fill his famished lungs.
A smoke grenade concealed Hodge's effort to render aid. Exhausted and mindful of an enemy determined to kill him, the Soldier turned his attention to the patient. A visual blood sweep indicated a severed femoral artery.
Hodge's training kicked in despite labored breathing. He cinched down the tourniquet and locked it in place.
Then the real work began.
With the help of squad member Spc. Dana Haddox, the two Soldiers hoisted Bustamonte over their shoulders and moved the Sailor out of the danger area. Despite the team effort, it was laborious work rushing the Sailor to the platoon casualty-collection point.
Once the trio reached the Casualty Collection Point, Hodge and Haddox joined forces to complete the MARCH algorithm.
Massive bleeding: The Soldiers completed a more thorough blood sweep, noting non-life-threatening venous bleeding in Bustamonte's legs.
Airway control: Though the corpsman was breathing normally, Hodge tilted his head back to ensure good airway.
Respiratory support: Since Bustamonte's wounds were only to his legs, Hodge knew he didn't need any support for a collapsed lung.
Hypothermia: Regardless of temperature, Behrens said hypothermia is always a risk for a traumatic injury. As such, Hodge wrapped Bustamonte in a space blanket.
If the scenario was real, Hodge would hand Bustamonte over to a flight medic in a medevac helicopter for evacuation to a medical facility. Though the medic has years of training to care for the wounded, Behrens said it is often non-medical service members armed with the MARCH algorithm who make a difference.
"MARCH allows us to greatly increase the survivability of traumatic injuries, and it ultimately allows Soldiers to go home alive," Behrens said.